Champion of the Month Nominations

Each month, SOURCE highlights an individual “Champion of the Month” from one of our 3 participating JHU health professional schools (JHSPH, SOM, SON). This is a great way to acknowledge a student, faculty, or staff person from our schools for their outstanding contribution to community engagement activities here in Baltimore.

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1.Nominator's name:

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2.Nominator's email:

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3.Nominator's school affiliation:

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4.Nominator's phone:

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5.Nominee's name:

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6.Nominee's email:

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7.Nominee's school affiliation:

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8.Nominee's phone:

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9.Is the nominee a student, faculty of staff member?

Student

Faculty

Staff Member

Answer the following questions for your nominee. Provide as much thoughtful information as possible about the individual to help inform the selection committee’s decisions.

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10.Describe the community engagement experience the nominee has participated in/led this academic year (include the name of the community organization(s) that the nominee worked with during their service experience).